Active NPI
Nicole Marie Della Longa, PHD
- Clinical Psychologist
- Seattle, WA
National Provider Identifier
1275030900
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY61116505
- Practice address
- 1200 5TH Ave Ste 800
Seattle, WA 98101-3136 - Phone
- (206) 374-0109
- NPI assigned
- Apr 9, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY61116505 | WA | Primary |
Addresses
Primary practice location
1200 5TH Ave Ste 800
Seattle, WA 98101-3136
Mailing address
1200 5TH Ave Ste 800
Seattle, WA 98101-3136
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 18, 2021 through Apr 18, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY61116505 | WA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1523232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618272000000",
"number": "1275030900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 5TH AVE STE 800",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981013136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 5TH AVE STE 800",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981013136",
"telephone_number": "206-374-0109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DELLA LONGA",
"first_name": "NICOLE",
"middle_name": "MARIE",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-04-09",
"last_updated": "2021-04-13",
"certification_date": "2021-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "PY61116505",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.